Nurses’ working motivation sources and related factors: A
questionnaire survey
1Said Bodur
2Selma İnfal
3 AbstractBackground: Motivation is an important issue for personnel management in health care settings, as it is related to both performance and intention to quit. Objectives: The study was aimed to determine nurses’ working motivation sources and related factors in hospitals. Design: Descriptive study. Settings: A state university hospital and a public hospital in Turkey. Participants: Two hundred and two nurses were randomly selected from each department in a university and in a public hospital. Methods: Data were collected using a socio-demographic questionnaire and the Motivation Sources Inventory and were analyzed using descriptive and inferential statistics. Results: Among five motivation sources, internal self-concept-based motivation was the highest and intrinsic process motivation was the lowest in nurses. There was a significant relation between scores of some motivation sources and managerial experience, income level, satisfaction from the unit, staff roles, and perception of work stress. Conclusions: Intrinsic process motivation, instrumental motivation, and external self-concept-based motivation sources may be improved to increase nurses’ total motivation.
Keywords: Motivation; Nurse; Hospital; Demography; Motivation sources
Introduction
Motivation is complex and multidimensional, and clearer defnitions for motivation are needed (Vilma and Egle, 2007). Many contemporary authors have attempted to define it. For example, Grafham et al. (2004) referred to motivation as a psychological process that gives direction to behavior, Be’gat et al. (2005) defined motivation as an internal drive that is present to satisfy unmet needs, and McLean and Anema (2004) described motivation as a will to achieve.
1This article was presented as poster in 11th National Congress of Public Health, (23-26 Oct 2007). Denizli, Turkey.
2 Prof. Dr., Balıkesir University Faculty of Medicine, Department of Public Health, Balıkesir, Turkey,
Leonard et al. (1999) proposed an integrative model of motivation built on research efforts in the field (Figure 1).
Figure 1: Integrative model of motivation
Their model integrated several theorists’ perspectives, identifying five sources of motivation: intrinsic process, instrumental, external and internal self-concept, and goal internalization. With intrinsic process motivation, the work itself acts as the incentive, as workers enjoy what they are doing. With instrumental motivation, rewards, such as pay, promotion, and bonuses, motivate the individual. With self-concept-external motivation, a person’s reputation or the way he or she is perceived by others is the motivating factor. With self-concept-internal motivation, the attainment of the ideal self serves as the motivation for behavior. With goal internalization, persons are motivated to work toward the goal of the collective (Barbuto, 2000).
Motivation is an important issue for personnel management in health care settings (Janssen et al., 1999), as it is related to both performance (Levy-Leboyer, 1988) and intention to quit (Tzeng, 2002; Yildiz, 2009). It is recommended that (Toode, 2011) further research should be carried out about nurses’ work motivation and the factors affecting it. The present study was devised to determine nurses’ motivation sources and related factors in public hospitals.
Methods
Nursing staff of a state university hospital and a public hospital in Konya (Turkey) were included in the descriptive study with permission of institutions (IRB). The sample size was calculated with a formula to determine the expected total motivation score (134±25) (Ozturk, 2002)
MOTIVATION
Intrinsic
Process Instrumental External self-Concept Internal Self-Concept Internalization Goal
Increase the Quality of
within 5 points of deviation and with a 95% confidence level and a power of 0.80 (n=198). Participants were selected using the unweighted random sample method based on units, and 202 nurses voluntarily participated.
Two forms were used to obtain data. A questionnaire was used to investigate socio-demographic features and working conditions. The Turkish version (Ozturk, 2002) of the Motivation Sources Inventory (MSI) developed by Barbuto and Scholl (1998) was used to measure the relative weight of motivation sources. This inventory consists of 5 subscales and 30 items and tested for validity and reliability (Cronbach’s alpha: 0.84).
Data were summarized as mean and standard deviation. In univariate analysis, t test and one-way ANOVA (with Tukey HSD) tests were used to compare more than two means with a normal distribution. Kruskal-Wallis H (with Bonferroni adjusted U test) and Mann-Whitney U tests were used for not normally distributed data. In multivariate analysis, a two-way ANOVA test was used when the number of independent variables was few; logistic regression analysis was used when the number was high by transforming scores into dummy variables according the median value. Relationship was evaluated by Spearman correlation coefficient among scores of motivation sources. P-value was considered significant when lower than 0.05.
Results
Mean age was 31±6 years and mean working experience was 10±7 years among nurses. Forty-five of them (22%) were male, and 131 (65%) were married; 50% had a technical school diploma, 39% had graduated from college, and only 11% had earned a bachelor’s degree. The total motivation score of nurses was 128±30 according to the MSI.
Internal self-concept-based motivation and goal internalization motivation were the highest contributors to working motivation, according to the MSI, whereas intrinsic process motivation was the lowest contributor (Table 1; Figure 2).
Table 1. Nurses’ motivations: Summary of data results (n=202)
Motivation Source Mean±SD Ratio Coefficient (α)
Intrinsic Process 16,7±8,7 0,131 0,60
Instrumental 23,7±8,1 0,186 0,65
External Self-concept-based 25,1±8,1 0,197 0,71 Internal Self-concept-based 34,6±7,4 0,271 0,83
Goal Internalization 27,4±7,6 0,215 0,65
Figure 2. Nurses’ ratio analysis of motivation sources
Tables 2 and 3 show motivation source scores according to socio-demographic and working condition variables and a comparison of the results obtained with univariate analysis. Intrinsic process, internal self-concept-based, and goal internalization motivation scores were related to very few of the independent variables, while instrumental and external self-concept-based motivation scores were related to many more.
Table 2. Nurses’ mean scores of motivation sources according to socio-demographic features Variables n Intrinsic Process Instru- mental External concept Internal concept Goal Inter- nalization Total Place of growth City 119 17,8 24,6 26,2 34,9 28,0 131,4 Metropol 83 15,2* 22,6 23,7* 34,3 26,7 122,4* Gender Male 45 18,4 25,6 25,4 33,7 27,4 130,4 Female 157 16,3 23,2 25,1 34,9 27,5 127,0
Age (years) 29 and below 91 17,8 24,6 26,4 35,2 28,0 132,0
30 and over 111 15,9 23,1 24,2 34,2 27,0 124,3*
Graduation Tech. school 101 17,4 24,9 25,8 35,4 28,2 131,8
College 101 16,1 22,6* 24,5 33,9 26,6 123,6* Marriage experience No 59 16,6 23,4 24,5 34,0 27,1 125,6 Yes 143 16,8 23,9 25,4 34,9 27,6 128,6 Parenthood No 82 16,8 23,6 24,8 34,4 26,8 126,4 Yes 120 16,7 23,9 25,4 34,8 27,9 128,6 Hospital University 125 17,0 23,1 25,6 34,5 26,7 126,8 Public 77 16,4 24,8 24,5 34,9 28,6 129,3 Working experience 0-9 years 101 18,3 25,1 26,7 35,6 27,9 133,6
10 yrs and over 101 15,2* 22,4* 23,6** 33,7 26,9 121,9**
Experience 0-4 years 108 17,6 24,9 26,1 34,9 28,2 131,7 Intrinsic Process 13,1% Instrumental 18,6% External Self-concept-based 19,7% Internal Self-concept-based 27,1% Goal Internalization 21,5%
in Hospital 5 yrs and over 94 15,7 22,5* 24,1 34,3 26,6 123,2* Income in month 799 $ and lower 91 18,1 24,5 27,1 34,9 27,9 132,5 800 $ and over 111 15,6* 23,1 23,6** 34,5 27,0 123,9* Spending allowance a No 53 15,5 24,8 23,7 33,8 27,2 124,9 Yes 149 17,2 23,4 25,7 34,9 27,5 128,7 Smoking No 102 15,6 22,6 25,2 34,9 27,0 125,3 Yes 100 17,9 25,0 25,1 34,4 27,9 130,2
a Some female participants are not allowed to spend their own salaries because male members of the family are in
control of family’s all income.
*P<0.05; **P<0.01
Table 3. Nurses’ mean scores of motivation sources according to working conditions Variables n Intrinsic Process Instru- mental External concept Internal concept Goal Inter- nalization Total
Job decision Family 69 17,5 23,5 24,7 34,1 26,6 126,4 Self 68 16,0 23,4 23,8 34,2 27,8 125,2 Employment Security 65 16,6 24,5 27,1 35,7 28,0 131,8 Unit Internal 81 17,6 22,4 24,5 33,7 27,7 125,8 Surgical 121 16,2 24,7* 25,6 35,3 27,3 129,0
Unit decision Self 59 16,0 23,7 24,2 35,5 28,4 127,8
Management 143 17,0 23,8 25,6 34,3 27,0 127,7 Managerial Experience No 159 17,4 25,0 25,8 34,9 27,7 130,9 Yes 43 14,2* 19,2** 22,7* 33,8 26,3 116,1** Current role Clinical nurse 146 16,8 24,5 25,4 35,2 28,1 130,0 Unit leader 40 17,3 23,4 26,5 34,5 26,9 128,6 Supervisor 16 14,9 18,1* 19,7* 29,7* 22,8* 105,1**
Working hours 45≤ hours 72 18,1 25,7 26,7 35,3 27,8 133,6
40-44 hours 130 16,0 22,7* 24,3* 34,3 27,2 124,5*
Watching duty No 83 16,3 21,8 24,5 34,1 26,5 123,2
Yes 119 17,0 25,2** 25,6 35,0 28,1 130,9*
Shift Night/Day 104 16,3 22,2 24,3 33,9 26,7 123,4
Rotation 98 17,2 25,4** 26,1 35,4 28,2 132,3*
Unit satisfaction Yes 129 16,4 22,8 24,2 34,2 27,3 125,0
No 73 17,2 25,4* 26,9* 35,4 27,6 132,5 Perception of working load Normal 133 16,1 23,1 24,2 33,8 27,0 124,2 High 69 18,0 24,9 27,0* 36,3* 28,3 134,5** Perception of working stress Normal 55 17,0 22,4 23,3 32,7 25,5 120,9 High 147 16,6 24,3 25,9* 35,4* 28,1* 130,3* Employment Security Yes 149 16,0 22,9 24,9 34,6 27,6 126,0 No 53 18,7 26,2** 25,9 34,7 27,0 132,6 *P<0.05; **P<0.01
Variables that were significantly related to motivation sources in the univariate analysis were included in the multivariate analysis to determine stronger relations. The number of these variables was so high that a two-way ANOVA could not be performed for some of the sources. To overcome this problem, motivation source scores were divided into two dummy variables (low and high according to median score). Finally, a logistic regression analysis was performed by using these dummy variables.
Intrinsic process (p=0.030) and instrumental (p=0.001) motivation scores were lower in nurses who had managerial experience. External self-concept-based motivation scores were lower in nurses with higher income (p=0.036) and nurses who were more satisfied with their unit (p=0.024). Internal self-concept-based motivation score was lower among managerial staff (p=0.011) but higher in nurses who perceived occupational stress as being high (p=0.034). Managerial staff also had lower scores in goal internalization motivation (p=0.024). Total motivation score was higher in nurses who perceived their stress levels as high (p=0.002). No relations were observed between other variables and motivation sources.
The most significant correlation between scores of sources of motivation, between Internal self-concept with the goal internalization (rs = 0.53, p <0.001) and External self-concept with ınstrumental (r = 0.40, p <0.001) (Table 4).
Table 4. Correlations between scores of motivation sources (intrinsic process, instrumental, external and internal self-concept, and goal internalization) (rs).
Goal
internalization Internal self- concept External self- concept Instrumental
Intrinsic process 0,195** 0,006 0,378** 0,368**
Instrumental 0,271** 0,154* 0,400***
External self-concept 0,312** 0,334**
Internal self-concept 0,526***
* Correlation is significant at the 0.05 level ** Correlation is significant at the 0.01 level *** Correlation is significant at the 0.001 level
Discussion
The participants were nurses serving in universities or public hospitals. They were young, with moderate working experience, and a low level of education. The nurses’ total motivation score was around what was expected. The relations between independent variables and motivation sources are discussed below.
Internal self-concept-based motivation was judged the most important motivation source for nurses (Table 1). Nurses are educated to manage diagnosis and treatment in a swift and sensitive way, which may facilitate the internalization of professional standards. Their drive to maintain these standards while completing work tasks without making mistakes during critical processes may explain the great importance of internal concept-based motivation for nurses. The internal self-concept based motivation score was higher among nurses who perceived working stress as high and lower among managerial staff. Dealing with the stress derived from nursing practice, which arises from hard work and the great responsibility placed on their shoulders, may have increased internal self-concept-based motivation scores, as this stress, hard work, and responsibility is a challenge for which nurses are prepared. The low score of internal self-concept-based motivation among nurses who play a managerial role instead of engaging in nursing practice may be explained by their occupying a position that is unrelated to their education or professional standards. Ozturk (2002) supported the idea that internal self-concept-based motivation is the most important motivation source. Because self-concept-internal motivation is based on personal challenge and self-authorship, organizational policies and procedures will not affect these individuals’ motivation (Barbuto et al., 2001). Therefore, the high scores associated with this motivation source are optimistic. However, Kilic and Kekelik (2012) didn’t supported the idea that internal self-concept-based motivation is the most important motivation source. Analyzing the factors that influence motivation shows us that firstly provide economic benefits such as salary and working capital are seen to be more motivating factors. Salary, which will be held in the revolving fund and other rights improvements, will positively affect the motivation of health workers and contribute to more efficient operation. Lambrou et al.., (2010)’s study showed that motivation was influenced by both financial and non-financial incentives. The main motivating factors for the health workers in this public hospital sample were appreciation by managers and colleagues, a stable job/income and training.
Goal internalization motivation is the second most important source of motivation in nurses (Table 1).
The respected nature of health service and the sense of duty coming from necessary teamwork may ease goal internalization for nurses. The low ratio between goal internalization motivation and total motivation among nurses with managerial duties may be explained by the low contribution of nurses in achieving managerial goals and the fact that the hierarchical management structure is the focus rather than teamwork. Sense of achievement was found to be the most important prime motivator among nurses (Ozturk et al., 2006), which supports the current study’s result that goal internalization is an important motivation source. Because of the more direct
relation between goal internalization and performance (Ozturk, 2002), human resource managers should focus their attention on how to improve goal internalization. On the other hand, Hakmal et al., (2012) supports the current study’s result which says that goal internalization is an important motivation source. Factors such as “appreciation at work, to participate in decisions and using initiative and take care of employees, fair disciplinary procedures, get new skills, to adopt corporate vision, do your job with great care, adequacy information and experience for the job” have had highly positive effect on nurses’ motivation.
External self-concept-based motivation is the third most important motivation source (Figure 1). Respect is proportional to education level and title in Turkish society. The participants had no title and their education level was low that they receive medium respect from society and the rest of the health care team. Nurses likely perceive their reputation in society similarly. Therefore, external self-concept-based motivation was not rated as high. The contribution of external self-concept-based motivation is higher in nurses with low income. Nurses who started working recently and who work temporarily are paid low wages in general. Yet the positive effects of escaping unemployment and having a job that society, and more specifically their family, respects may increase the contribution of self-concept-based motivation to nurses’ total motivation. Similarly, nurses without job guarantee were found to be more motivated (Özdemir, 2004). Other studies (Dieleman et al., 2003; Vilma and Egle, 2007) showed that the main motivating factors for health workers are appreciation by managers and colleagues and community gains rather than money (Mathauer and Imhoff, 2006). In a parallel way, the higher proportion of external self-concept-based motivation in nurses who are less satisfied with their unit may be caused by their continuing search for respect in society and management, which they could not find in their unit.
Instrumental motivation is a weak source of motivation for nurses (Table 1). This situation may be related to low salaries. Moreover, the possibility of changing material conditions positively is low for nurses in Turkey, which limits their expectations of the future. Instrumental motivation is a lesser motivator in nurses who had managerial experience. A probable cause for this may be the inability to satisfy material expectations, which are elevated because of managerial experience.
Intrinsic process is the weakest motivation source for nurses (Table 1). Intrinsic work motivation proved to be primarily determined by elements of the job that make the work challenging and worthwhile, such as skill variety and autonomy among nurses (Janssen et al., 1999). Nursing applications are less funny, attractive, and fascinating than other jobs because they require commitment and self-sacrifice. Still intrinsic attraction is found to be the most important factor while deciding to choose nursing as one’s profession (McCabe et al., 2005). This high intrinsic motivation may diminish over time because of nurses’ lack of autonomy. In other words, despite
acquiring multidisciplinary competencies, nurses do not have the opportunity to apply them in full value in the context of nursing practice because of the requisite hierarchical obedience to a physician (Vilma and Egle, 2007). So the weak effect of intrinsic process motivation is expected. Intrinsic process motivation scores were lower in nurses who had managerial experience. Participants with less intrinsic motivation may have looked for the fascination they could not find in nursing applications in managerial work, which may be the cause for this relation. Or nurses who had managerial experience are struggling to find the excitement in nursing applications they found earlier. Ozturk (2002), too, found the lowest ranked motivation source to be intrinsic process. To improve intrinsic work motivation among nurses, attention must be focused on the work content (Janssen et al., 1999).
As a conclusion, among motivation sources for nurses, internal self-concept-based motivation has the highest ratio (to the total), and intrinsic process motivation has the lowest. Intrinsic process motivation might be improved with greater variety in tasks, more autonomy, and more feedback. It can be because of the ones who live in metropolis cities, have a higher income and education level and have administrative experiences, and positions of responsibility increases, low scores on sources of motivation leading the high expectations. For this reason identifing and taking in to consideration expectations of the management staff can be may be helpful. The reasons that provide nurses harder working ambiance in the current time can be researched and the motivation offensive reasons can be improved. Total quality management is also considering the participation of people in management can increase motivation. Evaluating wages, , teamwork, guard system, the stres resources in environment at regular intervals by the management can contribute to employee satisfaction. Besides intrinsic process motivation, instrumental and external self-concept-based motivation sources may be improved to increase nurses’ total motivation.
References
Barbuto, J.E., Scholl, R.W. (1998). Motivation sources inventory: Development and validation of new scales to measure an integrative taxonomy of motivation. Psychol Rep. 82, 1011-1022. Barbuto, J.E., Brown, L.L., Wilhite, M.S., Wheeler, D.W. (2001). Testing the underlying motives of
organizational citizenship behaviors: A field study of agricultural co-op workers. 28th Annual National Agricultural Education Research Conference, 539-553.
Barbuto, J.E., Fritz, S.M., Marx, D. (2000). A field study of two measures of work motivation for predicting leaders’ transformational behaviors. Psychol Rep. 86, 295-300.
Be´gat, I., Ellefsen, B., Severinsson, E. (2005). Nurses’ satisfaction with their work environment and the outcomes of clinical nursing supervision on nurses’ experiences of well-being – a Norwegian study. J Nurs Manage. 13, 221-230.
Dieleman, M., Cuong, P.V., Anh, L.V., Martineau, T. (2003). Identifying factors for job motivation of rural health workers in North Viet Nam. Hum Resour Health. 1, 10.
Grafham, E., Matheson, C., Bond, C. (2004). Specialist drug misuse nurse’s motivation, clinical decision-making and professional communication: An exploratory study. J Psychiatr Mental Health Nurs. 11, 690-697.
Hakmal, H., Karadag, M., Demir, C. (2012). Investigation of factors affecting the motivation levels of nurses: A study in Gülhane Military Medical Faculty Training Hospital. Anatolian Journal of Nursing and Health Sciences, 15:3, 181-187.
Janssen, P.P.M., De Jonge, J., Bakker, A.B. (1999). Specific determinants of intrinsic work motivation burnout and turnover intentions: A study among nurses. J Adv Nurs. 29, 1360-1369.
Kilic, R., Keklik, B. (2012). A study about health care workers on the effect of the quality of work life and the motivation. Afyon Kocatepe University IIBF Journal (C.XIV, S II, 2012), 147-160. Lambrou, P., Kontodimopoulos, N., Niakas, D. (2010). Motivation and job satisfaction among
medical and nursing staff in a Cyprus public general hospital. Human Resources for Health 2010, 8:26
Leonard, N.H., Beauvais, L.L., Scholl, R.W. (1999). Work motivation: The incorporation of self-concept-based processes. Human Relat. 52, 969-998.
Levy-Leboyer, C. (1988). Looking at work motivation from a wider angle. Br J Guid Couns. 16, 242-249.
Mathauer, I., Imhoff, I. (2006). Health worker motivation in Africa: The role of non-financial incentives and human resource management tools. Hum Resour Health. 4(24), 1-17.
McCabe, R., Nowak, M., Mullen, S. (2005). Nursing careers: What motivated nurses to choose their profession? Aust Bull La. 31, 384-407.
McLean, T., Anema, M. (2004). Reduce the nursing shortage: Help inactive nurses return to work. J Contin Educ Nurs. 35, 211-215.
Ozdemir, E. (2004). Motivation level of nurses (Thesis). Istanbul, Marmara University [in Turkish]. Ozturk, H. (2002). The levels of motivation and performance in nurses (Thesis). Istanbul, Istanbul
University [In Turkish].
Ozturk, H., Bahcecik, N., Baumann, S.L. (2006). Nursing satisfaction and job enrichment in Turkey. Nursing Scie Q. 19, 360-365.
Toode, K., Routasalo, P., Suominen T. (2011). The impact of nurses' motivation to work. Int J Nurs Stud. 48, 246-257.
Tzeng, H.M. (2002). The infuence of nurses’ working motivation and job satisfaction on intention to quit: An empirical investigation in Taiwan. Intl J Nurs Stud. 39, 867–878.
Vilma, Z., Egle, K. (2007). Improving motivation among health care workers in private health care organizations: A perspective of nursing personnel. Baltic J Manage. 2, 213-224.
Yildiz, Z., Ayhan, S., Erdogmus, S. (2009). The impact of nurses' motivation to work, job satisfaction, and sociodemographic characteristics on intention to quit their current job: An empirical study in Turkey. Applied Nurs Res. 22, 113-118.
